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Introduction. Epidermal growth factor receptor (EGFR) is a transmembrane protein of the receptor tyrosine kinase family that is activated in various cancers (non-small cell lung cancer, colorectal cancer, head and neck tumors). In glial brain tumors, increased EGFR expression levels are characteristic of the most aggressive subtype, glioblastoma. Frequent structural changes of EGFR in glioblastoma are amplification of the chromosome region where the EGFR gene is located, point mutations, as well as deletion of exons 2–7 of the EGFR gene leading to the formation of EGFRvIII transcript.Aim. To determine structural changes of the EGFR gene (point mutations and amplification of the EGFR gene, EGFRvIII transcript) in tumor samples using different methods and to evaluate their potential clinical significance.Materials and methods. The study included 75 patients with brain gliomas (70 of them glioblastoma) aged 34 to 78 years (mean age 56 years). DNA and RNA isolation was performed from fresh frozen tumor tissue, as well as from peripheral blood leukocytes. EGFR gene mutations were determined by next-generation sequencing (NGS), and β allele frequency (BAF) comparative analysis (normal-tumor) was performed to determine the copy number of chromosome 7 regions. Quantitative polymerase chain reaction was used to confirm the EGFR gene amplification in tumor samples, and reverse transcription-PCR was used to detect EGFRvIII variant.Results. The NGS method revealed 11/70 (16 %) mutations in coding regions of EGFR gene in glioblastoma samples, the EGFR gene amplification was detected in 26/70 (37 %) cases; no structural changes of the EGFR gene were detected in 5 glioma samples (astrocytoma, oligodendroglioma). All cases of EGFR gene amplification detected by NGS were confirmed by quantitative polymerase chain reaction. To search for EGFRvIII transcript, 31 tumor RNA samples were examined, of which EGFR amplification was present in 12 samples. EGFRvIII transcript was detected only in samples with EGFR gene amplification – 4/12 (33 %). To assess the clinical significance of structural gene alterations, the frequency of occurrence in primary and recurrent glioblastoma samples was compared.Conclusion. The NGS method allows to detect both point mutations and amplification of the EGFR gene. The EGFR gene amplification was associated with EGFRvIII mutation in 33 % of cases. No statistically significant differences in the frequency of structural changes in the EGFR gene between primary and relapsed glioblastomas were found.

Introduction. The standard of treatment for patients with single cerebral metastases is surgery and radiosurgery. The use of these methods significantly increases survival rates.Aim. To compare the results of surgical treatment of patients with single and multiple cerebral metastases.Materials and methods. The study included 40 patients with single and multiple cerebral metastases who underwent neurosurgical intervention in the neuro-oncology department of the N.N. Blokhin National Medical Oncology Research Center from 2010 to 2022.Results. All patients are divided into 3 groups. Group A included 15 patients who removed all available cerebral foci (from 2 to 4). Group B included 10 patients with multiple cerebral metastases who underwent removal of one symptomatic metastasis. In group C, 15 patients who underwent removal of a single metastasis. It was noted that the survival of patients after removal of all cerebral metastases is identical to the survival of patients after removal of single metastasis 11.9 and 12.4 months, respectively. And it was significantly higher than the survival of patients who removed not all cerebral metastases 6.2 months (p = 0.03). Also in group A and C, the percentage of local relapses was identical. Improvement in neurological status was noted in all groups, there was only an increase in cognitive-mnestic disorders in group A, where all cerebral foci were removed. However, these disorders were moderate and did not reach the extent of dementia. The work done shows.Conclusion. Surgical removal of all metastases in patients with multiple brain metastases provides a prognosis similar to that of patients undergoing surgery for single metastasis. Removal of symptomatic metastasis in patients with multiple cerebral lesions in most cases leads to a regression of neurological symptoms and makes it possible to continue treatment with a group of patients whose condition was considered incurable. The percentage of local relapses in the removal of multiple cerebral metastases, subject to oncological principles, is the same as in the removal of single metastases.

Introduction. Glioblastoma (GB) is not yet curable despite recent advances in the treatment of other malignant solid tumors. The management of GB is based solely on histopathological features, imaging of the tumor and its genomic analysis (somatic mutations in the isocitrate dehydrogenase genes, methylation status of the O6-methylguanine-DNA methyltransferase gene promoter). To adapt the treatment to the most recent tumor evolution, molecular information should be received regularly throughout the course of therapy. However, tumor tissue is often not available for diagnosis as the disease progresses. In this regard, the development of less invasive methods, such as analysis of the proteome of biological fluids of patients, is of particular interest. Cerebrospinal fluid (CSF) is an important source disease biomarkers to monitor the presence and progression of the disease.Aim. To identify proteomic predictive biomarkers in the CSF of patients with GB.Materials and methods. During the study, samples of patients’ CSF samples, high-resolution proteomic mass spectrometry, modern biochemical methods and bioinformatic technologies were used.Results. For the first time, the analysis of proteomes of CSF samples of patients with GB obtained before and 7 days after the removal of the primary tumor was carried out. Potential biomarkers of GB have been identified. After their validation using open databases, 11 proteomic predictive markers of GB (S100A9, S100A8, PLA2G15, PPIB, LTBP2, VIM, LAMB1, STC1, NRP1, COL6A1, HSPA5) were selected and their role in the molecular mechanisms of gliomagenesis was assessed. Conclusion. The proposed panel of proteomic predictive CSF biomarkers in GB patients can be further used in the development of test systems for assessing the effectiveness of therapy and early detection of disease relapses.

Introduction. Treatment of glioblastoma multiforme remains little effective due to the rapidly developing recurrence of the tumor, due to its high tumorigenic potential, resistance to chemoradiation therapy and increased dissemination of glioma stem cells. The identification of potential therapeutic targets, which make it possible to more effectively destroy glioma stem cells, becomes topical. In this regard, the study of ferroptosis (FP), which can cause the death of tumor cells with a highly malignant phenotype, is of great importance. However, FP and its regulatory pathways in the GSC are not fully understood. At present, it is also not clear how FP differs for glioma stem cells and glioblastoma differentiated cells.Aim. To study the expression of ferroptosis signaling cascade determinants in CD133+ glioma stem cells and CD133- glioblastoma differentiated cells using high resolution proteomic mass spectrometry.Materials and methods. High-resolution proteomic mass spectrometry, cell technologies.Results. In total, 1970 proteins were identified, 15 of which are associated with ferroptosis and are present in both cell populations. Upregulation of 12 FP determinants (ACSL1, ACSL3, COPZ1, FTH1, FTL, GPX1, GPX4, PCBP1, SLC3A2, TFRC, VDAC1, VDAC2) was found in CD133+ glioblastoma stem cells compared to CD133- differential glioblastoma cells, 10 of which were more than 2-fold overexpressed.Conclusion. Important regularities have been established in the expression of ferroptosis determinants and proteins controlling this process in glioma stem cells, which can be used in the development of new approaches to the detection of potential targets for the therapy of glioblastoma multiforme.

According to the literature, metastatic brain damage in kidney cancer occurs in 6.5 % of patients. The introduction of new techniques associated with the use of targeted drugs, immune checkpoint inhibitors and innovative radiation therapy techniques can significantly increase patient survival. Effective drug therapy and local control of brain metastases are of paramount importance for predicting overall survival and quality of life for patients. This literature review summarizes the scientific literature data on the use of local and systemic methods of treatment in patients with metastases of kidney cancer to the brain.

Glioblastoma multiform^ is one of the most aggressive malignancies, wich standard of treatment not changed over the past decade, and the average life expectancy from diagnosis to death does not exceed two years in the most optimistic trials. The review examines the features of the glioblastoma microenvironment, its genetic heterogeneity, the development of recurrent glioblastoma, the formation of drug resistance, the influence of the blood-brain barrier and the brain lymphatic system on the development of immunotherapy and targeted therapy. Molecular subgroups of glioblastomas with an assumed prognostic value were analyzed. It was determined that numerous relationships between glioblastoma cells and the microenvironment are aimed at ensuring tumor progression, and also cause a state of reduced effector function of T cells. Data on the development of future molecular-targeted therapies for four types of cancer cells based on their different properties and response to therapy are summarized: primary GSC, RISC cells, and proliferating and postmitotic non-GSC fractions. The penetration of blood-brain barrier with chemotherapeutic drugs and antibodies currently remains the main limitation in the treatment of glioblastoma. The resulting analysis of the causes is reduced to the following conclusions. A detailed understanding of the evolutionary dynamics of tumor progression can provide insight into the related molecular and genetic mechanisms underlying glioblastoma recurrence. The most promising methods of treatment for glioblastoma are combined therapy using immune checkpoint inhibitors in combination with new treatment methods -vaccine therapy, CAR-T-cell therapy and viral therapy. A deeper study of the mechanisms of drug resistance and acquisition resistance, biology and subcloning clonal populations of glioblastoma and its microenvironment, with active consideration of combined trips to the treatment will increase the survival rate of patients, and may lead to stable remission of the disease.

Brain metastases from clear cell uterine carcinoma are extremely rare and are associated with a poor prognosis.Case report. A case of metastasis to the cerebellum in a 55-year-old patient with uterine adenocarcinoma is presented. The diagnosis of uterine cancer T2N1M1, stage IV was established in 2016. Extirpation of the uterus, lymph node dissection, radiation and chemotherapy were performed. In 2018, the patient developed neurological symptoms. On MRI scan a tumor in the posterior cranial fossa was found. Without progression in other organs and the area of the primary focus. The tumor was resected. Histology: brain metastasis from clear cell uterine adenocarcinoma. Radiation and chemotherapy were performed. The patient’s neurological symptoms regressed. In the future, a complete response to the treatment was recorded.Discussion. Our case illustrates a rare metastasis from clear cell uterine adenocarcinoma. Brain metastases from uterine adenocarcinoma do not have a specific radiographic feature. Management of such patients should include a combined treatment, which can increase life expectancy. The life expectancy of our patient at the time of the control examination was 29 months.

Esophageal cancer spreads locally via the circulatory and lymphatic systems and can, extremely rarely, form brain metastases. The development of intracranial metastases is a long-term adverse event indicating poor prognosis. In this paper, we present a case of esophageal cancer with a brain metastasis in a patient who received combination therapy and demonstrated long-term progression-free survival.

The study objective is to assess the possibilities of magnetic resonance imaging (MRI) in SWI (susceptibility weighted imaging) in the differential diagnosis of glial brain tumors and primary brain lymphomas. Materials and methods. Fifty-four patients with brain tumors were studied (men – 27 (50 %), women – 27 (50 %)). Average age 57.9 years. Histological examination of the surgical material revealed the glial nature of tumors in 41 patients (26 of them with glioblastoma, anaplastic astrocytomas – 15), primary brain lymphomas – in 13 patients. Brain MRI was performed using tomographs with a magnetic field of 3 and 1.5 T. A semi-quantitative assessment of the data obtained in the SWI mode based on the classification of ITSS (intratumoral susceptibility signals), reflecting the severity of interstitial vascular architectonics and microbleeding. Results. The degree of ITSS was 3 in glioblastomas (G4 ) in 26 (100 %) cases, in the structure of gliomas (G3 ) the ITSS values were 3 in 3 (20 %) cases, in the remaining 12 (80 %) cases – ITSS 2. In the group of primary brain lymphomas, the ITSS 1 was in 4 (30.7 %) cases, ITSS 0 was in 9 (69.3 %) cases. Conclusion. MRI in SWI mode is a promising technique that allows one to quantify the degree of pathological changes in tumor vascular architectonics and intratumoral hemorrhages and has shown high specificity in the differential diagnosis of malignant gliomas and lymphomas of the brain, accompanied by active accumulation of contrast medium.

The article presents a clinical case of long-term complete remission after combined treatment in patient with metastasis of ovarian cancer in the brain. Duration of remission after treatment was more than 7 years.

Meningeal hemangiopericytomas are rare tumors of the meninges developing from pericytes. The main method of their treatment is surgery aimed at total removal of the tumor. Analysis of the literature studies shows high potential of post-operative distant radiation therapy to increase duration of relapse-free survival of these patients. The recommended total radiation dose varies from 50 to 60 Gy (and in some publications, it exceeds 60 Gy). Radiation is applied as classic fractionation and hypofractionation, and different types of radiosurgery and stereotaxic radiotherapy are suitable approaches to treatment of recurrent meningeal hemangiopericytomas in patients with a history of radiation therapy.

Background. Priority objectives of surgical neurooncology (diagnosis verification, tumor cytoreduction, and preservation of patient’s functional status) can be achieved both through traditional neurosurgical approaches and through the use of keyhole surgery. Keyhole surgery allows to minimize unnecessary, extended resection of the skull base and long-term static brain tissue retraction.Objective. The authors present preliminary results of the use of supraorbital keyhole craniotomy in intra- and extra-axial brain tumors. Materials and methods. In 2014–2016, 45 patients were operated through supraorbital craniotomy to treat intra- and extra-axial tumors. The majority of patients (n = 28) was diagnosed with anterior cranial fossa meningiomas. Gliomas of the frontal lobe were diagnosed in 12 patients. The average tumor size ranged from 3 to 3.5 cm.Results. Mortality, disability, or serious permanent access-related complications were not observed in our group. In all cases, the transition to the classical craniotomy was not required. Periorbital edema and transient hypoesthesia were observed in all patients. Permanent frontal hypoesthesia was observed in 3 patients (4 %) for a time period up to six months. According to postoperative MRI performed in all patients at the time of discharge, in the group of intra-axial brain tumor gross-total removal was observed in 8 patients (47 %), in 9 patients (53 %) the tumor was near-totally removed (more than 90 % of the tumor), in the group of meningiomas all 28 patients had gross-total removal. Conclusion. Supraorbital craniotomy can be an effective and safe alternative to classic approaches to treatment of extra-axial tumors of the anterior cranial fossa and intra-axial tumors of the frontal lobe. The approach requires a very careful selection of patients, individualization of surgery, and further critical evaluation.

The effectiveness of traditional chemotherapy (with temozolomide, fotemustine, lomustine) alone or in combination with whole brain radiotherapy in melanoma patients with cerebral metastases does not exceed 7–10 % with no significant impact on survival, which is around 2–4 months. Targeted therapy helped to improve survival of patients with disseminated melanoma and BRAF V600 mutations. The use of targeted drugs in patients with brain metastases allows to control the tumor process and to succeed in treatment of cerebral metastases. According to currently available research data and our own results, the effectiveness of targeted therapy with vemurafenib in melanoma patients positive for BRAF V600 mutations with brain metastases reaches 18.0–44.5 % with median survival of 5.3–8.0 months. Evidences suggest that the use of vemurafenib in melanoma patients with brain metastases ensure effective disease control in most of the cases and has a significant advantage comparing to conventional chemotherapy and whole brain radiotherapy. According to the results of these studies vemurafenib can be recommended as a 1st line targeted drug for treatment of melanoma patients with BRAF V600 mutations and brain metastases. Despite the existence of blood-brain barrier and efflux systems, new targeted drugs showed promising results in treatment of brain metastases. Over the last few years we have enhanced our understanding of brain metastasis mechanisms, principles of blood-brain barrier functioning, and ways of cancer drugs penetration into the central nervous system. Targeted therapy is constantly developing and will play an increasing role in treatment of melanoma cerebral metastases in the future with finding of new targets.

Lung cancer is mostly common occurring oncological disease in the developed countries. Currently lung cancers are subdivided into nonsmall-cell (adenocarcinoma, large-cell, squamous cell) and small-cell. The difference in the clinical and morphological picture leads to the necessity of choosing therapeutic approaches to patients of various groups.Lung cancer should be referred to encephalotropic diseases since metastatic lesion of the central nervous system is sufficiently common complication. Successes of complex treatment of primary tumor result in increase of total longlivety currently ther is ageing of patients suffering lung cancer. These factors increase the risk of metastatic lesions of the brain.Interest to the problem of neurosurgical treatment of patients suffering lung cancer is determined by frequency of lesion, varicosity of morphological variants of the disease, requiring various algorithms of treatment and diagnosis.The main role of neurosurgical intervention in cerebral metastases of lung cancer consist in creation of the paled of carrying out combined therapy. Ideally, a neurosurgical operation should be carried out with clearcut observance of oncological principles of ablasty.Adequate comprehensive approach to treatment or patients with cerebral metastases of various forms of lung cancer with the developed of optimal tactics of and stages of treatment would make it possible to increase duration and quality of life of patients.

The paper gives the results of treatment in a female patient with locally advanced thyroid cancer with a tumor thrombus in the internal jugular vein with laryngeal or tracheal involvement, and a giant metastasis into the bone of the vault of the skull.

In patients with kidney cancer (KC), the rate of metastatic brain involvement is 2-11%, is steadily growing, and is one of the important reasons for treatment failures in these patients. Surgery and radiotherapy, including radiosurgery, must be considered as optimal treatments for patients with KC and brain metastases. Systemic drug therapy has recently played a more and more increasing role in the treatment of patients with a progressive brain tumor process. At the same time, there are no exact pharmacokinetic data on drugs registered for the treatment of disseminated KC in respect to their concentration in the human central nervous when they are used in therapeutic doses. On the basis of the data of the literature review and the results of the authors’ studies, it may be concluded that while none of the target agents has still shown any significant advantage over others in treating KC patients with brain metastases. All the drugs have demonstrated their ability to achieve a clinical and X-ray verified objective effect (as stabilizations in most cases) in treating brain metastases. The most data are available on the therapeutic efficacy of sunitinib and sorafenib. In case of progressive brain tumor process, drug treatment should be individually discussed in each situation in accordance with standard approaches to treating patients with disseminated KC.

Hepatocellular carcinoma ranks 5th in prevalence and 3rd in cancer mortality worldwide. The prognosis of this disease is very poor: the 5-year survival rate was not more than 3–5%. Metastases generally occur in the lung, in the lymph nodes of the abdomen, chest, and neck, in the vertebrae, kidneys, and adrenals. The cases of brain metastasis from hepatocellular cancer are very rare. Overall, the prognosis is very poor for patients with brain metastases from hepatocellular carcinoma. Nevertheless, solitary brain metastases and good hepatic function are favorable survival criteria; thus, the treatment of this group of patients may lead to their better survival. The paper describes a clinical case of brain metastasis from hepatocellular carcinoma in a patient receiving the combination treatment involving neurosurgical treatment and targeted therapy.

Chondroid skull base tumors are a rare and little studied pathology; many problems of their classification, diagnosis and treatment remain to be solved. This group of neoplasms is referred to as bone tumors arising from the cartilaginous tissue of the skull base bones, particularly from the bones formed during chondral osteogenesis. The paper details the clinical picture, X-ray and morphological diagnosis of chondroid tumors. Particular attention is given to surgery and radiotherapy for this category of tumors.

The paper analyzes treatments for glioblastoma. The role of resurgery, reradiotherapy, and antitumor drug therapy in the treatment of recurrent glioblastoma has been studied. Multicenter trials of the use of temozolamide and temozolomide in combination with bevacizumab have been reviewed. It has been shown that the use of bevacizumab to treat patients with glioblastoma makes it possible to increase survival and to improve quality of life.

The paper considers the experience with capecitabine in 67 patients with brain metastatic lesion from breast cancer. The immediate efficacy of capecitabine and the results of therapy with the agent were analyzed in the groups of its use alone and in combination with radiotherapy both for therapeutic purposes and as an adjuvant regimen. In the chemoradiation therapy group, the objective effects in the brain were 73 %. The median time to progression was 12.27 months. In the monochemotherapy group, the objective effects were 30 %. The median time to progression was 4 months. The results of the investigation show that capecitabine has pronounced antitumor activity and moderate toxicity. Combination treatment is the method of choice.

Piloid astrocytoma (PA) is a low-grade (WHO grade I) glial tumor that is more common in pediatric patients. According to the data of many authors, stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) promote long-term remission or delayed tumor progression in patients with inoperable tumors after incomplete removal of a tumor and with its recurrence. So it is urgent to determine the place and role of SRS and SRT in the combination treatment of patients with deeply located PA.Subjects and methods. In the period April 2005 to May 2010, the Department of Radiology and Radiosurgery, Neurosurgery Research Institute, Russian Academy of Medical Sciences, treated 101 patients diagnosed as having intracranial PA. Of them there were 70 children (aged 17 years inclusive) and 31 adults; 51 men and 50 women. The median age was 15.1 years (9.8 years for children and 28.7 years for adults). Tumor was histologically pre-verified in 90 (89.2 %) patients (tumor ablation in 83 cases and biopsy in 7). The diagnosis of PA was made on the basis of clinical and X-ray data in 11 (10.8 %) patients. ART was used in most cases (n = 66 (66.3 %)). SRS was performed in 35 (34.7 %) patients.Results. The median follow-up of the patients from the onset of disease was 52 months (range 2–228 months). Eighty-eight (87 %) patients could be followed up. On completion of the follow-up (December 2010), 87 (98.8%) of the 88 patients receiving SRT and SRS were alive. The median follow-up from the initiation of radiotherapy was 22.7 months (range 6–60 months). Tumors were enlarged in 20 (22.7 %) patients; those were due to cysts in 18. Eighteen patients were reoperated on. Histological specimens were examined and comparatively analyzed in 12 operated patients. The tumor changes accompanied by a reduction of the solid component and an increase of the cystic component were found to be a manifestation of tumor reactive-degenerative alterations as a consequence of radiation pathomorphi sm.Conclusion. SRT and SRS are effective treatments in patients with primary or recurrent PA irrespective of the tumor site and must be performed early after non-radical tumor removal. At present (median follow-up 22.7 months), tumor growth is controlled in 98 % of the

Cerebral metastases occur with 10 to 30 % of all oncological patients. Hemorrhages into cerebral metastases are one of the most dangerous complications of the metastatic process. With that, cerebral metastases of such widespread solid malignant tumors as melanoma, kidney cancer, germ cell tumors, less frequently, lung cancer and breast cancer are prone to hemorrhages. The purpose of the work is to improve the results of surgical treatment of patients with brain metastases complicated with hemorrhages.Materials and methods. Surgical treatment of 69 patients with brain metastases complicated with hemorrhages was performed in N.N. Blokhin Russian Cancer Research Center. Hemorrhage on the macroscopic level was confirmed intraoperatively and in accordance with the results of the morphological study of surgical drugs. Total microsurgical resection of one or several cerebral metastases with hemor rhages was performed regarding all patients studied. The time interval of observation of patients after the surgical treatment comprises 1 to 72 months. There were 27 women and 42 men. The age range was from 18 to 74 y.o. Besides, the state of veins of lower extremities and the state of the coagulation blood system in accordance with the data of coagulograms was studies. The analysis of the macrostructure and the microstructure of metastases with hemorrhages as well as the morphological study of the brain tissue adjacent to hematomas was performed with a morphological study and histological techniques. The patients were distributed in accordance with the RPA (recursive partitioning analysis) classes: I class (n = 7), II class (n = 39), III class (n = 23); in accordance with the hemorrhage type: intratumoral type (26 metastases), perifocal type (20), mixed type (32); in accordance with the histological principle: melanoma (n = 25), lung cancer (n = 13), kidney cancer (n = 17), breast cancer (n = 4), colorectal cancer (n = 1), soft tissue sarcoma (n = 4), non-seminomatous germ cell tumor (n = 5).Results. Early post-surgical lethality comprised 6 % (n = 4). Development of local relapses comprised 16 % (n = 11). Extracerebral development of the disease has become the reason of death of 59 % of patients, development of the disease in the brain has become the reason of death of 41 % of patients. The shortest survival median was found with patients suffering from melanoma and comprised 6 months, with the III class of RPA, it comprised 6 months, with the perifocal hemorrhage type, it comprised 6 months, the longest survival median was found with patients suffering from sarcoma and comprised 15.5 months, with the I class of RPA, it comprised 14 months, and with the intratumoral hemorrhage type, it comprised 14.5 months.Conclusions. Development of local relapses depended on the surgical intervention technique and did not depend on the availability of tumor elements in the hematoma. Separated resection of the metastasis and perifocal hematoma does not violate oncosurgical principles and does not cause the rate of local relapses; the common survival median of patients after surgical treatment comprised 9 months. The factors that determined survival of patients with cerebral metastases with hemorrhages were the histological form of the primary tumor, type of metastasis hemorrhage and RPA class of the patient prior to the surgery.

Our investigation has demonstrated the high efficiency of combined chemotherapy (CT) including procarbazine + lomustine or procarbazine + lomustine + vincristine in patients with anaplastic oligodendrogliomas. Postoperative CT has been recently recommended for patients with deletion of chromosomes 1p and 19q, by taking into account the good prognosis of a therapeutic effect, better parameters of time till progression in this patient group, and a risk for cognitive impairments after brain radiotherapy.

The main tasks of the study were to evaluate the efficiency of treatment and to estimate time to progression and survival rates in patients with recurrent glioblastomas receiving combination treatment with irinotecan and bevacizumab. Five (41.7 %) patients achieved partial regression; disease stabilization and progression were observed in 5 (41.7 %) and 2 (16.6 %) cases, respectively. The median time to disease progression was 5.5 months; 6-month and one-year survival rates were 66.6 and 25 %. The median overall survival was 9.0 months. Treatment tolerability was satisfactory. Thus, the preliminary results of our study show the high efficiency of a combination therapy regimen incorporating bevacizumab and irinotecan for patients with recurrent glioblastomas and they are comparable with the data available in the literature on investigations of the efficiency of this treatment regimen. This study is being continued.

Since 2006, the N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, has been conducting an investigation of the efficiency of targeted therapy with gefitinib in patients with brain metastasis from non-small cell lung carcinoma (NSCLC). The evaluation of treatment efficiency in 9 patients with tumor EGFR mutation in NSCLC revealed that 1 (11.1 %) and 5 (55.6 %) patients achieved complete and partial regression, respectively; disease stabilization was observed in 3 (33.3 %). The median time to progression was 7 months; the patients did not achieve the median survival. The evaluation of treatment efficiency in a group of 6 patients without tumor EGFR mutation or its evidence showed complete and partial tumor regressions; disease stabilization was noted in 3 (50.0 %); disease progression was in 3 (50 %). The median time to progression was 2 months; the median survival was 5 months. Thus, the high efficiency of treatment with the EGFR inhibitor gefitinib in patients with brain metastases from NSCLS was achieved only in a group of patients with found ECFR mutations in exons 18–21 in the tumor. Determination of the status of ECFR in the tumor is the most important prognostic factor when using therapy with the EGFR tyrosine kinase inhibitor gefitinib in patients with brain metastases. The investigation is being continued.

Radiotherapy (RT) is a standard treatment for breast cancer (BC) patients with metastatic brain involvement. All patients (n = 15) had already received chemotherapy (CT) for the underlying disease when they were found to have brain metastases. To develop effective CT regimens for patients with recurrent brain metastases, who have received RT to the brain, is a serious problem. Combination CT with gemcitabine and cisplatin showed a high efficacy (complete and partial regressions were achieved in 47.7% of cases) and fair survival rates (median 10 months) in a group of patients with BC brain metastases and a poor prognosis.

Brain metastases from uterine cervical carcinoma are very rare. The development of intracranial metastases is a long-term adverse event indicating poor prognosis. In this paper, we present a case of cervical cancer with a brain metastasis in a patient who received combination therapy and demonstrated long-term progression-free survival.

The treatment tactics of patients with cerebral metastases of various solid tumors in the brain currently does not have a accurate determination. This article presents a discussion of the choice of treatment options for patients with cerebral metastases of solid tumors. Discussexistingrecommendations,identifies controversies.